NURS 6521 week 1 Discussion: Pharmacokinetics and Pharmacodynamics

NURS 6521 week 1 Discussion: Pharmacokinetics and Pharmacodynamics

Advanced practice nurses will be working with a multitude of individuals and it is important for an advance practice nurse to know and understand pharmacokinetics and pharmacodynamics of the different medications that they will be prescribing throughout their career.  According to Rosenthal and Burchum (2018), pharmacokinetics is the study of drug movement throughout the body and pharmacodynamics is the study of the biochemical and physiologic effects of drugs on the body and the molecular mechanisms by which those effects are produced.  Pharmacokinetics involves four basic processes which includes absorption, distribution, metabolism, and excretion (Rosenthal & Burchum, 2018).

A 68-year old female comes to the hospital because she is feeling flushed and just not feeling like herself.  Upon examination the patient is hypertensive and slightly tachycardic.  The patient does not have any complaints of pain.  The patient has a health history of anxiety, depression, COPD, hypertension, and chronic kidney disease.  The patient is being admitted for hypertensive crisis.  The patient takes a serotonin reuptake inhibitor for her depression, an ace inhibitor for her hypertension.

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One factor to consider while treating this patient is their chronic kidney disease.  The chronic kidney disease could be one reason that the patient is having uncontrolled hypertension and will also need to be considered when treating this patient with new medications.  A second factor could be the patient’s compliance with medication regimen at home.  A third reason could be environmental exposure.

One of the first things that would need to be done would be to ask the patient about her compliance with her home medication regimen.  It would be important to obtain a renal function panel to determine if the patient was in acute renal failure.  After this information is obtained a better plan of care could be made for the patient’s long-term treatment.

If a patient is having acute kidney failure or injury the alterations of drug responses are attributed to pharmacokinetics and that at least 50% of all essential medications are influenced by kidney dysfunction (Keller & Hann, 2018).  The four basic processes of pharmacokinetics play a major role in renally compromised patients.  All four phases involve movement and if one phase is compromised it can cause a disruption in the effectiveness of the medication.

Environmental exposures can also be taken into consideration when considering the pharmacokinetics and pharmacodynamics of the effectiveness of a medication.  In a recent study it was shown that environmental pollutants such as pesticides can alter drug-metabolizing enzymes, as well as pharmacokinetics of drug metabolism (Banerjee, 2020).

In conclusion, having the full details of this patient’s case would be beneficial in determining a full treatment plan.  After the hypertensive crisis was under control then I would continue with the patient’s home dose and continue to monitor the patient.  The patient may need to have an increase in their medication, or they may need to add in a secondary medication for hypertension.

References

Banerjee, et al.  (01/17/2020).  Effect of environmental exposure and pharmacogenomics of drug metabolism. 

DOI: https://doi.org/10.2174/1389200221666200110153304

Keller, F., & Hann, A.  (2018).  Principles of drug response and alterations in kidney disease.  CJASN September 2018, 13 (9) 1413-1420; DOI: https://doi.org/10.2215/CJN.10960917

Rosenthal, L. D., & Burchum, J. R. (2018). Lehne’s pharmacotherapeutics for advanced practice providers. St. Louis, MO: Elsevier.

When selecting drugs and determining dosages for patients, it is essential to consider individual patient factors that might impact the patient’s pharmacokinetic and pharmacodynamic processes. These patient factors include genetics, gender, ethnicity, age, behavior (i.e., diet, nutrition, smoking, alcohol, illicit drug abuse), and/or pathophysiological changes due to disease.

For this Discussion, you reflect on a case from your past clinical experiences and consider how a patient’s pharmacokinetic and pharmacodynamic processes may alter his or her response to a drug.

To Prepare

• Review the Resources for this module and consider the principles of pharmacokinetics and pharmacodynamics.
• Reflect on your experiences, observations, and/or clinical practices from the last 5 years and think about how pharmacokinetic and pharmacodynamic factors altered his or her anticipated response to a drug.
• Consider factors that might have influenced the patient’s pharmacokinetic and pharmacodynamic processes, such as genetics (including pharmacogenetics), gender, ethnicity, age, behavior, and/or possible pathophysiological changes due to disease.
• Think about a personalized plan of care based on these influencing factors and patient history in your case study.

By Day 3 of Week 1

Post a description of the patient case from your experiences, observations, and/or clinical practice from the last 5 years. Then, describe factors that might have influenced pharmacokinetic and pharmacodynamic processes of the patient you identified. Finally, explain details of the personalized plan of care that you would develop based on influencing factors and patient history in your case. Be specific and provide examples.

By Day 6 of Week 1

Read a selection of your colleagues’ responses and respond to at least two of your colleagues on two different days by suggesting additional patient factors that might have interfered with the pharmacokinetic and pharmacodynamic processes of the patients they described. In addition, suggest how the personalized plan of care might change if the age of the patient were different and/or if the patient had a comorbid condition, such as renal failure, heart failure, or liver failure.

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link, and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!

As an Intensive Care Unit (ICU) nurse of 10 years, I have taken care of a variety of different people with a broad spectrum of illnesses and problems. Pharmacokinetics, or how the body processes a drug, must be carefully considered for the best treatment options (Rosenthal & Burchum, 2018). A typical patient diagnosis that can be particularly difficult to manage medically is drug and alcohol abusers. Their drug tolerances and organ impairment related to damage from abuse can make it especially challenging to treat their conditions.

I vividly remember taking care of a patient in their early 30s who was admitted to the medical intensive care unit that I worked in for alcohol withdrawal. He had no past medical history except for alcohol and benzodiazepine abuse. He was found by a family member in alcohol withdrawal and was immediately brought to the hospital. The clinical institute withdrawal assessment for alcohol scale (CIWA), was used to determine the severity of withdrawal. This scale views different symptoms of withdrawal such as nausea/vomiting, tremors, sweats, anxiety, agitation, visual and auditory disturbances, headache, and orientation (MERCK Manual Professional Version, 2020). His CIWA score was extremely high, which showed severe withdrawal.

Typical treatment for alcohol withdrawal includes the administration of benzodiazepines in order to get through the detox process. This drug helps lessen the withdrawal symptoms. When giving this patient a standard dose of benzodiazepines such as Ativan or Valium, there was no decrease in clinical symptoms. This was because of his history of benzodiazepine abuse and increased tolerance. Increased drug administration and frequency were ordered until the patient’s withdrawal symptoms were under control. However, the patient also had liver damage from alcoholic cirrhosis. Benzodiazepines are drugs that are metabolized by the liver (Brett & Murnion, 2015).  Since the liver was not functioning correctly, the medications administered to control alcohol withdrawal were not processed appropriately by the liver, causing a buildup of the drugs (Louvet & Mathurin, 2015). The patient became unresponsive, and an advanced airway was placed for airway protection.

I feel that this patient’s care could have been handled differently. Due to this patient’s history, a different plan of treatment should have been initiated. I feel that by following the standard protocol for alcohol withdrawal treatment, the outcome of this patient getting intubated was inevitable. However, the patient will remain unresponsive until his body cleared all of the benzodiazepine drugs. This could be a lengthy process and delay his care further. I would have suggested intubation and mechanical ventilation from admission, and to use sedation safe for the liver. By doing this, the patient would be able to overcome his detox safely and have his breathing tube removed sooner. This would decrease any other risks associated with prolonged mechanical ventilation.

References

Brett, J., & Murnion, B. (2015, October). Management of benzodiazepine misuse and dependence. Australian Prescriber, 38(5), 152-155. http://dx.doi.org/https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4657308/

Louvet, A., & Mathurin, P. (2015, March 15). Alcoholic liver disease: mechanisms of injury and targeted treatment. Nature Reviews Gastroenterology, 12, 231-242. Retrieved from https://www.nature.com/articles/nrgastro.2015.35

MERCK Manual Professional Version. (2020). CIWA. Retrieved February 27, 2020, from https://www.merckmanuals.com/professional/multimedia/clinical-calculator/CIWA%20Ar%20Clinical%20Institute%20Withdrawal%20Assessment%20for%20Alcohol%20Scale

Rosenthal, L. D., & Burchum, J. R. (2018). Lehne’s pharmacotherapeutics for advanced practice providers. St. Louis, MO: Elsevier.

Pharmacokinetics refers to the processes that the body subjects a drug to once administered. These processes include absorption, distribution, metabolism, and excretion. Contrarily, pharmacodynamics describes the effects that a drug has on the body, such as changes in the physiological processes and the side effects. The two processes are affected by different patient characteristics, such as age and gender. I have worked with the pediatric patient population and observed the two concepts in these patients. Lu and Rosenbaum (2014) define the pediatric population as consisting of neonates, infants, developing children, and adolescents. Their age affects pharmacokinetics and pharmacodynamics in various ways.

I have learned a lot from my experience with pediatric patient populations. First, the effective administration of drugs is tremendously challenging. This is because the rapid developments taking place inside the body have profound effects on pharmacokinetics and pharmacodynamics. For example, the gastric PH of a pediatric patient changes rapidly from birth through to childhood, which affects the efficiency of orally administered drugs. In addition, their physical size and physiological factors such, as membrane permeability, vary as the individual matures. In one instance, medicine administered to two children with similar conditions, and with an age differential of two months, had different results due to fast growth rate.

Administering drugs to pediatric patient population requires careful consideration of their unique physical and physiological characteristics. For example, the difference in the physical size between neonates and infants require that they are given different dosage sizes. Growth occurs very fast when the child is young, and it is critical to have the exact age and weight to administer the correct dosage. Another essential factor to consider in administering drugs is the PH of the gut. At birth, for example, gastric PH is neutral. Administering drugs to neonates should then consider the chemical composition of drugs administered orally to ensure they are effective (van den Anker et al., 2018). Every child should be treated uniquely as the rate of growth, and bodily changes vary.

References

Lu, H., & Rosenbaum, S. (2014). Developmental pharmacokinetics in pediatric populations. The Journal of Pediatric Pharmacology and Therapeutics, 19(4), 262-276.

van den Anker, J., Reed, M. D., Allegaert, K., & Kearns, G. L. (2018). Developmental changes in pharmacokinetics and pharmacodynamics. The Journal of Clinical Pharmacology, 58(10), S10-S25.

Response

Great job on explaining how medication administration can be influenced on patient factors such that of a pediatric patient. I work on the opposite end of the spectrum-gerontology patients so reading your discussion post was interesting and educational. I did some additional research on how medication administration and prescribing is different upon the pediatric population.

In review of literature one potential restraint that providers have when it comes to the pediatric patients is considering the likelihood that oral medications may be rejected due to the taste and texture that they are available in. It is essential for providers to understand the developmental pathway that occurs in terms of pediatric patients. According to Eidelman & Abdel-Rahman (2016), “the capacity to discriminate sweet and umami is present in utero, followed by texture, temperature and piquancy at 1–2 years of age and finally bitter, salty and sour around the age of 2 years. Olfactory senses do not appear to fully mature until children are 5–7 years of age. Other adaptive behaviors, which typically manifest by 2–5 years of age, influence a child’s willingness to accept novel foods, and by extension, medicines” (Eidelman & Abdel-Rahman, 2016, p.70). It is essential that providers are aware of all of the available forms and flavors that medications come in to ensure that medication is not rejected by the pediatric patient to ensure that the medication is effective. I found this factor interesting as it is not something that I would have considered or thought to consider prior to reviewing the content that is covered in this week’s material.

Cultural differences that may exist between the prescribing provider and the patient and their families should also be taken into consideration when prescribing medications. Many different cultures will often use traditional and herbal medications in addition to mainstream medications so having a clear understanding of these cultural differences and being able to ask appropriate questions to identify other health practices is essential as traditional and herbal medications can influence the effectiveness and interactions between the two treatment options (World Health Organization, 2007, p.10).

Eidelman, C. &.-R. (2016). Pharmacokinetic considerations when prescribing in children. International Journal of Pharmacokinetics, 69-80.

Organization, W. H. (2007). Promoting Safety of Medicines for Children. Geneva: WHO Press.

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